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Tackling early socioeconomic inequalities as important as encouraging smoking cessation

19 November 2013

Although health behaviours such as smoking are directly
linked to the majority of early deaths in the UK,
tackling these individual factors fails to address the underlying cause. To get
to the root of the problem, childhood deprivation must be addressed because it
promotes damaging health behaviours in adult life. So say researchers from UCL
in a study published in the Journal of
Epidemiology & Community Health.

The study aimed to quantify the effects of early
life circumstances on people’s propensity to smoke, and the link between lower
social status and increased risk of early death.

Professor Eric Brunner (UCL Department of
Epidemiology and Public Health), senior author of the research, says: “We set out to understand whether the risk of early death is passed from one
generation to the next by social and economic disadvantage. Our research, based
on a cohort of babies born in 1946, shows that inequalities in childhood and early
adult life directly impact on social inequalities in mortality in later life.

Early life circumstances clearly have a huge effect on the health behaviours people exhibit into adulthood.... Our work provides evidence that social inequalities in health will persist unless prevention strategies tackle the intergenerational transmission of disadvantage and risk.

Professor Eric Brunner, UCL Epidemiology and Public Health

“What we found was that whether people smoke or not
accounts for a significant amount of the social difference in premature
mortality,” continues Professor Brunner. “However, when we factor in people’s
early life circumstances, the independent explanatory power of smoking behaviour
reduces from 51 per cent to 28 per cent. The difference is explained by the
social and economic inequalities people experienced in their formative years.

“Early life circumstances clearly have a huge
effect on the health behaviours people exhibit into adulthood. For example,
many teenagers in the study started smoking, and childhood advantage predicted
successful quitting. This pattern of quitting leads to the familiar social
patterning of smoking in middle age. Our
work provides evidence that social inequalities in health will persist unless
prevention strategies tackle the intergenerational transmission of disadvantage
and risk.”

The
researchers analysed data from 2,132 participants who were born in 1946 and
followed to the age of 66 as part of the 1946 Birth Cohort (MRC National Survey
of Health and Development). Socioeconomic circumstances were measured during
childhood (based on the father’s social class when the participant was aged 4,
and the level of maternal education when the participant was aged 6) and at the
age of 26 (based on the participant’s educational attainment, home ownership
and the social class of their head of household).

Lead author Ingrid Giesinger says: “Differences in childhood and early adult
circumstances are underlying causes of social inequalities in both adult health
behaviours and mortality in the immediate post-war generation. Policies focused
only on adult health behaviours do not address the socially patterned causes of
these behaviours, or the independent role played by these causes in social
inequalities in health.”

David
Buck, Senior Fellow at health think-tank The Kings Fund, says: “We welcome this
study which demonstrates how important early life experiences are directly to
our long-term health, and how this is reinforced through shaping our health
behaviours which then track through to adulthood and early death. This
strengthens the case for increased investment in narrowing inequalities in
early childhood experience, as well as measures to support quitting smoking and
other damaging health behaviours in adults.”

-Ends-

Additional information:

Previous studies have
investigated the ‘socioeconomic gradient in mortality’ (i.e. the link between
lower social status and increased risk of early death). One recent study
demonstrated that when people’s behaviour over an extended period of time (24
years) is factored in, almost three quarters (72%) of the social gradient can
be explained by smoking, drinking, diet and exercise. However, what this
earlier work failed to address is the impact of poor circumstances in childhood
and early adulthood on later health behaviours.